Fish Oil and ADD/ADHD

Fish oil supplement better than Ritalin
ADELAIDE, AUSTRALIA. Attention-deficit hyperactivity disorder (ADHD) is a rapidly growing problem in the Western world. It is estimated that 5-10% of school-age children (mostly boys) in Europe suffer from the disorder. Comparative figures for the USA and Australia are 3-7% and 11%. Major symptoms of the disorder are difficulty in sustaining attention, hyperactivity, and impulsivity. ADHD is also associated with learning difficulties in reading, spelling, and math and may involve psychiatric problems that follow the child into adulthood. There is considerable evidence that ADHD is linked to a fatty acid deficiency or imbalance. Long-chain fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are essential to proper brain functioning and several studies involving children with ADHD have shown that they are deficient in these essential fatty acids. Researchers at the University of South Australia report that an EPA and DHA containing supplement is effective in reducing ADHD symptoms.

Their clinical trial involved 103 Australian children (74% boys) between the ages of 7 and 12 years. The children had all been diagnosed with ADHD and had scores two standard deviations or more above the general population on the Conners abbreviated ADHD Index. The trial participants were randomized to receive either placebo capsules (palm oil), fatty acid capsules (providing 560 mg/day of EPA, 175 mg/day of DHA, 60 mg/day of gamma-linolenic acid, and 10 mg/day of vitamin E), or fatty acid capsules + a multivitamin tablet containing low (RDA) amounts of vitamin and minerals.

After 15 weeks all children were given fatty acid capsules + daily multivitamin for a further 15 weeks. They were evaluated for ADHD symptoms after 15 and 30 weeks. At 15 weeks their scores on the Conners Parent Rating Scale were significantly reduced in regard to hyperactivity, inattention and impulsivity, and improvement was also noted in the sub-scores for perfectionism and social problems. There was no indication that adding the multivitamin to the fatty acid regimen had any additional benefits. Improvements continued until the end of the trial at week 30 at which time 40-50% of the treated children showed improvements corresponding to at least one standard deviation on the Conners ADHD Index. This improvement is equivalent to, or slightly better than, the improvement observed after 4 weeks of treatment with short-acting methylphenidate (Ritalin).

According to Canadian researchers who performed a meta-analysis of 62 randomized trials of Ritalin, there is no evidence that this drug is effective beyond 4 weeks and there is considerable evidence of its many adverse effects including decreased appetite, insomnia, headaches, stomach aches, drowsiness, anxiety, irritability, and dizziness.
Sinn, N. and Bryan, J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. Journal of Developmental & Behavioral Pediatrics, Vol. 28, April 2007, pp. 82-91
Schachter, HM, et al. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? Canadian Medical Association Journal, Vol. 165, November 27, 2001, pp. 1475-88

Fish oils reduce ADHD symptoms
OXFORD, UNITED KINGDOM. Neurodevelopmental disorders are becoming increasingly common among school-age children. It is estimated that about 5% of British school children suffer from developmental coordination disorder (DCD), while 1-2% suffer from attention deficit/hyperactivity disorder syndrome (ADHD). In the United States the prevalence of ADHD is estimated at 4%. DCD is characterized by problems with motor function (manual dexterity, ball skills and balance) and difficulties in learning, behavioural problems, and lack of social skills. The main symptoms of ADHD are cognitive problems (problems with thinking, learning and remembering), hyperactivity, anxiousness, shyness, perfectionism, opposition, social problems, excessive talkativeness, restlessness and noisiness.

It is well established that the main components of fish oil, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), together with the omega-6 fatty acids, arachidonic acid (AA) and dihomogamma linolenic acid (DGLA), play a major role in the structure of neuronal membranes. There is also substantial evidence that children with ADHD tend to be deficient in EPA and DHA.

Considering this evidence, researchers at Oxford University decided to investigate whether supplementation with fish oils would help children with DCD and ADHD. Their clinical trial involved 100 children between the ages of 5 and 12 years who had been diagnosed with DCD and showed symptoms of ADHD as well. The children were randomized to receive 6 placebo (olive oil) capsules a day or 6 capsules a day of an essential fatty acid (EFA) mixture providing a total of 558 mg of EPA, 174 mg of DHA, 60 mg of gamma-linolenic acid plus 10 mg of natural alpha-tocopherol (vitamin E). Half the children received the EFA mixture for 6 months, while the other half received the placebo for 3 months and then the EFA mixture for the remaining 3 months of the trial.

The improvements in the EFA groups were substantial. While no improvement was noted in motor skills, both reading and spelling skills improved significantly. The mean increase in reading age for the first 3 months was 9.5 months in the EFA group versus 3.3 months in the placebo group. Similarly, the increase in spelling age during the first 3 months of the trial was 6.6 months in the EFA group versus 1.2 months in the placebo group. Improvements in ADHD symptoms were also substantial, particularly in regard to hyperactivity, cognitive problems, anxiousness and shyness. The rate of improvements noted for the first 3 months continued for the subsequent 3 months of the trial. The researchers conclude that the EFA supplement may be a safe, tolerable and effective treatment for improving academic progress and behaviour among children with DCD.
Richardson, A.J. and Montgomery, P. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics, Vol. 115, May 2005, pp. 1360-66

Attention-deficit disorder in adults
SUNBURY, OHIO. Attention-deficit hyperactivity disorder (ADHD) is characterized by hyperactivity, emotional instability, poor coordination, short attention span, poor concentration, impulsiveness, and learning disorders. It is very common among school-age children with an incidence of between four and twenty per cent. Dr. Eugene Arnold, MD, Professor of Psychiatry at Ohio State University, points out that ADHD is not just a childhood disorder, but can be found among adults as well. Dr. Arnold has just completed an exhaustive survey of alternative treatments for adult ADHD. Although none of these treatments have undergone strictly controlled clinical trials some of them may nevertheless be worth a try. Relaxation training, biofeedback, meditation and massage are safe therapies that may have benefits. Fish oil supplementation, vitamins and minerals (in RDA dosages), herbal and homeopathic remedies, laser acupuncture, and anti-fungal (Candida) therapy may also be of benefit. Thyroid dysfunction and chronic lead poisoning are possible causes of ADHD and should be investigated and treated if necessary. Chelation is effective in removing lead. Zinc and magnesium supplementation may be useful if a deficiency is present and St. John’s wort (hypericum) should at least be given a pilot study according to Dr. Arnold. Arnold, L. Eugene. Alternative treatments for adults with ADHD. Annals of the New York Academy of Sciences, Vol. 931, June 2001, pp. 310-41

Docosahexaenoic acid deficiency may be key to ADHD
WEST LAFAYETTE, INDIANA. It is estimated that 3-5% of the school-age population in the United States suffer from attention-deficit hyperactivity disorder (ADHD). Prominent symptoms of this disorder are a poor attention span, inability to complete tasks, hyperactivity, and a tendency to interrupt others. Almost one quarter of children with ADHD also suffer from one or more specific learning disabilities in math, spelling or reading.

A study first reported in 1995 linked ADHD to a deficiency of certain long-chain fatty acids. These acids (arachidonic, eiscosapentaenoic, and docosahexaenoic acids) are all metabolites of the two essential fatty acids, linoleic acid (omega-6) and alpha-linolenic acid (omega-3). Researchers at Purdue University are now leaning towards the conclusion that a subclinical deficiency in docosahexaenoic acid (DHA) is responsible for the abnormal behaviour of children with ADHD. They point out that supplementation with a long-chain omega-6 fatty acid (evening primrose oil) has been unsuccessful in ameliorating ADHD and believe this is because ADHD-children need more omega-3 acids rather than more omega-6 acids. The researchers also found that children with ADHD were breast fed less often as infants than were children without ADHD. Breast milk is an excellent source of DHA. A study is now underway to investigate the effect of oral supplementation with DHA on the behaviour of ADHD-children. Burgess, John R., et al. Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. American Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 327S- 30S

Fish oils may help dyslexic children
GUILDFORD, UNITED KINGDOM. Dyslexia is a fairly common condition which involves difficulties in learning to read and write, mirror reversals of letters and words, and poor short-term memory. Dyslexia is closely related to dyspraxia (problems with coordination and muscle control) and attention-deficit hyperactivity disorder. It is estimated that about 10% of the populations of the United States and the United Kingdom suffer from dyslexia and 4% are severely affected. There was a 3-fold increase in the prevalence of learning disorders in the USA over the period 1976 to 1993 and 80% of the new cases involved dyslexia.

Dr. Jacqueline Stordy of the University of Surrey believes that dyslexia, dyspraxia, and attention-deficit hyperactivity disorder have one common denominator – a deficiency of long-chain fatty acids. She points to a study which found improved dark adaptation (a problem among dyslexics) after supplementation with 480 mg/day of docosahexaenoic acid (a main constituent of fish oil) for a month. Another study involving 15 dyspractic children found that supplementation with a proprietary mixture of tuna oil, evening primrose oil, thyme oil, and vitamin E for 4 months markedly improved their motor skills. The mixture provided 480 mg of docosahexaenoic acid, 35 mg of arachidonic acid, 96 mg of alpha-linolenic acid, 80 mg of vitamin E, and 24 mg of thyme oil daily. Dr. Stordy concludes that long-chain polyunsaturated fatty acid supplements may benefit children with dyslexia, dyspraxia, and attention-deficit hyperactivity disorder and notes that large, double-blind, placebo-controlled studies are already underway to verify this hypothesis. Stordy, B. Jacqueline. Dark adaptation, motor skills, docosahexaenoic acid, and dyslexia. American Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 323S-26S

Your brain needs DHA
NEW YORK, NY. Dr. Barbara Levine, Professor of Nutrition in Medicine at Cornell University, sounds the alarm concerning a totally inadequate intake of DHA (docosahexaenoic acid) by most Americans. DHA is the building block of human brain tissue and is particularly abundant in the grey matter of the brain and the retina. Low levels of DHA have recently been associated with depression, memory loss, dementia, and visual problems. DHA is particularly important for fetuses and infants; the DHA content of the infant’s brain triples during the first three months of life. Optimal levels of DHA are therefore crucial for pregnant and lactating mothers. Unfortunately, the average DHA content of breast milk in the United States is the lowest in the world, most likely because Americans eat comparatively little fish. Making matters worse is the fact that the United States is the only country in the world where infant formulas are not fortified with DHA. This despite a 1995 recommendation by the World Health Organization that all baby formulas should provide 40 mg of DHA per kilogram of infant body weight. Dr. Levine believes that postpartum depression, attention deficit hyperactivity disorder (ADHD), and low IQs are all linked to the dismally low DHA intake common in the United States. Dr. Levine also points out that low DHA levels have been linked to low brain serotonin levels which again are connected to an increased tendency to depression, suicide, and violence. DHA is abundant in marine phytoplankton and cold-water fish and nutritionists now recommend that people consume two to three servings of fish every week to maintain DHA levels. If this is not possible, Dr. Levine suggests supplementing with 100 mg/day of DHA. Levine, Barbara S. Most frequently asked questions about DHA. Nutrition Today, Vol. 32, November/December 1997, pp. 248-49

Hyperactive children lack essential fatty acids
WEST LAFAYETTE, INDIANA. Children suffering from attention-deficit hyperactivity disorder (ADHD) are inattentive, impulsive, and hyperactive. Researchers at Purdue University now report that hyperactive children have lower levels of key fatty acids in their blood than do normal children. Their experiment involved 53 boys aged 6 to 12 years of age who suffered from ADHD, but were otherwise healthy and 43 matched controls. Analyses showed that the boys with ADHD had significantly lower levels of arachidonic, eicosapentaenoic, and docosahexaenoic acids in their blood. The hyperactive children suffered more from symptoms associated with essential fatty acid deficiency (thirst, frequent urination, and dry hair and skin) and were also much more likely to have asthma and to have had many ear infections. The researchers conclude that ADHD may be linked to a low intake of omega-3 fatty acids (linolenic, eicosapentaenoic, and docosahexaenoic acids) or a poorer ability to convert 18-carbon fatty acids to longer more highly unsaturated acids. The researchers conclude that supplementation with the missing fatty acids may be a useful treatment for hyperactivity. Stevens, Laura J., et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. American Journal of Clinical Nutrition, Vol. 62, No. 4, October 1995, pp. 761-68

ADHD and essential fatty acids
AUCKLAND, NEW ZEALAND. Researchers at the School of Medicine at the University of Auckland released a fascinating report which throws a great deal of light on the question “Why are hyperactive children different from normal children”?

The study involved 48 hyperactive children and 49 age- and sex-matched controls. The hyperactive children were selected based on input from both teachers and parents and all participants were evaluated using four behaviour rating scales. The researchers discovered numerous, statistically significant differences between hyperactive and normally behaved children:

Hyperactive children had significantly lower birth weights and learned to walk later than normal children;

Hyperactive children were more likely to have frequent coughs and colds (44% vs. 8% among normal children);

52% of hyperactive children had an abnormal degree of thirst compared to only 6% in the control group;

Hyperactive children were more likely to have speech and language difficulties (32% vs. 6%) and difficulties in learning (67% vs. 6%).

Blood analyses showed that hyperactive children had significantly depressed levels of docosahexaenoic, dihomogammalinolenic, and arachidonic acids. Other research has found that hyperactive children also tend to have lower zinc levels. The researchers point out that male animals require 3 times as much EFAs (essential fatty acids) as do females in order to achieve normal neonatal and infant development; this is consistent with the finding that hyperactivity is far more common among boys than among girls. They also report that they carried out a double-blind, placebo-controlled, crossover study of supplementation with evening primrose oil in 31 selected hyperactive children. No benefits of the supplementation were observed. NOTE: This study was partially funded by Efamol Research Ltd., a manufacturer of evening primrose oil supplements. Mitchell, E.A., et al. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clinical Pediatrics, Vol. 26, August 1987, pp. 406-11

About Bradford S. Weeks, MD

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